Archive for September, 2012

Accidently Getting to Active Care

Posted: September 24, 2012 in Uncategorized

Sometimes it’s better to be lucky rather than good.

I happened to stumble upon this clinical tidbit a few weeks ago and just wanted to share.

It involves kinesio tape. You know, the stuff that every single Olympic athlete had on…

water matches tape which matches swimsuit…I see what you did there

For most of us, kinesio tape is another tool in the tool box used to help decrease pain, give the patient a soft barrier of support, and act as a ‘treatment while out of the office.’ I consider it a passive modality (although one in which the patient can be active while wearing, which is awesome), and one that, just like anything else, can be overused and relied upon once it is no longer needed.

More recently however, I used kinesio tape and it became as much of a diagnostic tool as a passive care modality. (hence the reason for this post)

……….

I was on my way out of the clinic the other day when one of our trainers came up to me and mentioned his shoulder has been bothering him. He is currently training for a bench press competition and just felt like his shoulder was not right. Because I had somewhere I had to be, I asked the trainer if I could just tape him to see if that offered him some relief until I could really spend some time to figure out what was going on.

I used this tape job, which I got from Dr. Greg Doerr. It has become my go-to for many shoulder issues.

I saw the trainer a few days later, and he told me the tape did help his shoulder feel about 20% better. Obviously, it was just a band-aid to get through the workout, but it gave me a great idea of where to go with my treatment.

Now, what I needed to do was almost re-create what the tape did with exercise.

My go-to has become HA (Heavy ASS) Kettle-Bell carries. Along with a plethora of other benefits (grip strength, anti-lateral flexion training, sweating, and grunting) HA Kettle-Bell carry does wonders for patients presenting with bench pressing/impingement/meathead syndrome. Interestingly, I think most people think that when someone is in pain, heavy training should be avoided. However, many times heavy loading is EXACTLY what they need.

If you don’t believe me, check out this post from Dr. Jeff Cubos.

To give people an idea of the weights we use in the office, I usually start with around 40lbs and have worked my way up to 70lbs. Keep in mind, all patients I have used this with so far are what I would consider ‘in shape’ with years of training experience under their belt.(this is not a requirement) Also, I usually don’t even tell the patient how much weight I am giving them, because I know that some would get nervous to be lifting something so heavy while they are in pain. After the exercise, once they are feeling better, I then tell them how much they are carrying.

For the visual learners…

So what did the tape actually do in the first place?

In my eyes, when that specific tape job makes the shoulder feel better, it simply tells me that I need to get the shoulder “back and down.” The patient needs upper trap, levator scap, and the pectoralis muscle to take a chill pill all while waking up middle trap, lower trap, and the rest of the scapular stabilizers.

All in all, this exercise has been a great find for me and my patients. In fact, I would go out on a limb and say it has been the most effective way to decrease shoulder pain in the quickest amount of time.

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Are We Creating Monsters?

Posted: September 18, 2012 in Uncategorized

Some horrible news over the past few weeks really made me stop and think…

For those of you who have not been following, it was these two stories that honest- to- god made me question everything I know.

Oakland A’s pitcher Brandon McCarthy, taking a line drive off his head can be found here.

Tulane football player Devon Walker, fracturing his spine during a game can be found here.

I guess I need to tell you my story so you can see where I am coming from…

For as long as I can remember, sports has been something that literally controlled my life. Nobody forced me to play, and I know my parents would have been just as happy if I decided to join the debate team, computer club, or the band (I actually was in the band from 4th-12th grade, but that’s neither here nor there).

In kindergarten, I was with my mother at the grocery store and being, well, in kindergarten, I decided that it was a good idea to casually take a handful of gummy worms out of the candy dispensers, bypass the weigh machine, and stick the candy directly into my mouth.

Yes, this is stealing. (I was 6, let me live)

Well, my mother saw this and certainly was not happy. I obviously needed to be punished. So, how do you punish a 6-year-old so he really, really gets the point?

Take away his toys? Nope.

Take away television? Negative.

No dessert? Not enough.

Not letting him go to recreation soccer practice? Damn, mothers always know how to make a point.

This crushed me. As a 6-year-old, soccer practice was my life. It was like telling Snookie she can’t go to Bamboo.

The point here is that I really, really love sports.

…….

In high school during my senior year, I went to throw a cut block on a defensive lineman. He tried to hop over me, but didn’t jump high enough. His knee caught my low back pretty good. I thought it was bruised, so I kept playing. This went on for another two quarters until I collapsed on the field because I simply couldn’t run anymore.

The team doctor took me back to the locker room and we found blood in my urine.

From there, I was sent to the hospital and stayed overnight. They found that I had bruised my kidney and fractured the L4 and L5 Transverse Process vertebrae.

I was told that I would need to be in a back brace for 6 weeks in order to let the injury heal.

I was crushed. 6 weeks in a high school football season is over half the year.

During my 6 weeks away from the field, my coach decided to put me up in the coaches booth with head phones so I could help call both the offense and defense. Staying involved with the team was something I NEEDED.

After 6 weeks of inactivity and in a brace, I removed the brace and without any Physical Therapy (the doctor said I didn’t need it, and amazingly I believed him) I returned to the field after 1 day of practice.

This was really dumb and I payed for it a bunch of years later with surgery.

But you know what?

I wouldn’t change any of it. 

The fact that I was able to go back on the field and play again was worth it, in my opinion. Just that one last chance to get out there  is something you never, ever get back.

The point: I really, really love sports.

…….

Since that time I went on to play college baseball. Ironically, my career ended there with a torn labrum on a hook slide into home plate during the 2nd week of my junior season.

…….

I tell these stories because I think before I go on, everyone must understand where I have come from. I come from a place in which I believe in building tough SOB’s with a no-nonsense attitude toward sports and training. Neither is/was something I did to hang out with friends, or build a social group. To me, it was ALWAYS serious business. Luckily, for most of my career, school came a bit easier for me so I in turn, spent 98% of my time focused on sports. Simply put, sports was never what I did, it was who I was. Quite frankly, it’s who I still am.

So that brings us back to the present.

I am now a chiropractor with a fascination in rehab and human performance. One who is always reading the research, going to seminars, and always looking for that ‘edge’. That ‘edge’ is generally anything that pushes human performance to another level.

Essentially, we all want to know (myself included) how to make our athletes bigger, faster, and stronger all while trying to keep them healthy.

But the question is when is enough, enough? When have we taken it too far?  What needs to happen for us to make drastic changes?

Think about the situation with Brandon McCarthy. Yes, I understand this was more of a freak injury. A line drive directly back at the pitcher’s head is not common. But, at some point it comes back to simple physics. The pitchers are continually throwing harder, the batters are getting stronger and subsequently hitting the ball harder. The pitcher’s mound has not moved back at all. So, what’s left is simply less reaction time and a higher velocity of which the ball is reaching the mound.

And then we look at the football situation. Trust me, I am well aware that poor technique can cause a freak injury to happen. But, no technique in the world can stop 250 lb. men from running at each other at freakishly high speeds literally trying to take each others head off.

As an industry, we are in the business of making better athletes. By doing this though, are we making these sports more dangerous?

At what point is it too much?

How far will we push the limits of human performance until we truly regret it?

As the title states, I am truly afraid we are creating monsters and I’m not sure where it ends.

Recently on the Facebook machine, I mentioned that I was halfway done reading The Talent Code by Daniel Coyle. In short, it was absolutely fantastic. Moreover, it’s a book that pretty much everyone could get something out of. From a rehab specialist, to trainer, teacher, or coach, this book truly spans the professions.

That all being said, I found a few random points of interest that I wanted to expand upon.

Let us first establish that any action or skill performed requires a complex of signals traveling at different speeds to and from the brain (grossly oversimplified, but work with me people) then I believe Dr. Douglas Fields, director of the Laboratory of Developmental Neurobiology at the National Institutes of Health explains the essence of myelin perfectly. Essentially, (and this will all make sense later)

Signals have to travel at the right speed, arrive at the right time, and myelination is the brain’s way of controlling that speed.

1) As I began getting into the book, I couldn’t help making a connection to fascia. Throughout, Coyle continually refers to this new ‘discovery’ of myelin, similar to that of fascia.

More to the point, any of us out there who went through a year (or years) of anatomy remember the dissection where our objective of the day was to often locate a muscle and its origin/ insertion. How did we get to the muscles? We cut through layer upon layer of skin and fascia, carelessly pushing it to the side so we could get to the ‘prize’ of muscles, tendons, and ligaments. However, science now shows us just how important the fascial connections of the body are.

Nobody does it better that Thomas Myers in Anatomy Trains.

similarly, the discovery of myelin has become something of a revelation to the scientific community. Neurologists are now calling it the “holy grail for acquiring skill.” For years, myelin was basically overlooked as “just an insulator” with no real purpose, but now it’s the coolest thing since Tebowing.

2) In a section near the end of the book, Coyle calls attention to clinical psychology. Specifically, a clinic in California is called ‘The Shyness Clinic’ literally works with people who lack social skills. How does this relate to myelin and skill development? Actually, the therapists believe that a lack of social skills is not because they are in fact ‘shy’ but because they haven’t practiced being social sufficiently (therefore not developing myelin for this skill or action).

Yes, this was interesting to me, but not what caught my attention. This quote from Dr. Albert Ellis, the godfather of this type of therapy was what truly stood out:

The problem with most therapy is that it helps you feel better. But you don’t get better. You have to back it up with action, action, action.

In training or rehab, this knocks the ball out of the park. Simply getting people out of pain is where the treatment just begins. Giving people strategies and lifestyle modification options that they can easily employ is ‘getting people better’. Practicing and preaching this is ‘action, action, action’.

3) Finally, an interesting thought on Alzheimer’s disease:

One of the most reliable predictors for Alzheimer’s onset is level of education

As we engage in deep practice, we add bigger, thicker myelin to our circuits. This in turn helps us compensate for the earlier stages of the disease. This is why we should encourage our geriatric population to continue with card games, crossword puzzles, or anything else they may find interesting so to keep their minds engaged and myelin at work.

As I said from the start, this book is something I would highly recommend as it may change the way you look at the world.

Have a great day!

09/11/01- ALWAYS REMEMBER

If you follow me through the machine that is Facebook, then you probably saw that my last blog drew some serious controversy. In case you missed it, here is the thread from the Rehab to Performance club (NYCC) page. Coincidently (or not), this post also happened to be my most popular of all time. I guess everyone really loves them some crazy.

How else could anyone stomach an entire season of the Kardashian’s?

Realize, when I sat down to write that post, it wasn’t specifically to create a stir. Like most of my posts, it was simply something I thought of during the day and I wanted to share. It was a thought process, or a ‘what if’ analysis of the situation. Really it was simply the question,

If I didn’t know where this person hurt, would it change my findings as to why this person hurt?

Anyway, I’m getting a bit off topic.

What I really wanted to talk about was what happens when people disagree or don’t like what you have to say.

While I am in no way an expert blogger or even semi-popular, I certainly have gotten questions about writing (mostly from students). I think if I could tell them one thing, it would be that you must accept the responsibility that comes with publishing work for the world to see. This isn’t a perfect universe, things that taste good usually aren’t healthy, and not everyone is going to love everything you have to say.Deal with it.

Furthermore, I have never gotten more out of a blog post that I have published than the previous one. Why? It inspired a discussion. And, some of the people who chimed in are people who I look up to a great deal. Some, I would pay out-of-pocket (and have) just to hear their opinion.

You see, my mentors have all told me the same thing. Private practice can get very lonely, very quickly. There is nobody to bounce ideas off of, get a second opinion, or just keep you honest and on your toes. Therefore, as much as technology has its downfalls, a huge positive is the ability to stay connected. At times it’s an insight into a thought process, a tough patient encounter, a cool new exercise, or even a glimpse into someone’s clinic.

I believe these lessons are invaluable as a new or veteran clinician.

In the end, I always say the same thing. If one person learned (and maybe laughed) from any of my posts, I think I have done my job. And from the feedback I have gotten from some close friends, I have certainly done my job.

And on that note…

Have a great day!